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Sleep-Wake Disorders in Stroke—Increased Stroke Risk and Deteriorated Recovery? An Evaluation on the Necessity for Prevention and Treatment

  • Stroke (H Diener, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Sleep-wake disorders (SWD) are common not only in the general population but also in stroke patients, in whom SWD may be pre-existent or appear “de novo” as a consequence of brain damage. Despite increasing evidence of a negative impact of SWD on cardiocerebrovascular risk, cognitive functions, and quality of life, SWD are insufficiently considered in the prevention and management of patients with stroke. This narrative review aims at summarizing the current data on the bidirectional link between SWD and stroke.

Recent Findings

Several studies have demonstrated that sleep-disordered breathing (SDB) is an independent risk factor for stroke and has a detrimental effect on stroke recovery. Short and long sleep duration and possibly other SWD (e.g., insomnia, circadian rhythm disorders) may also increase the risk of stroke and influence its outcome. Data on SDB treatment increasingly indicate a benefit on stroke risk and evolution while treatment of other SWD is still limited.

Summary

A systematic search for SWD in stroke patients is justified due to their high frequency and their negative impact on stroke outcomes. Clinicians should actively consider available treatment options.

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Abbreviations

AHI:

Apnea-hypopnea index

ASV:

Adaptive servoventilation

BDNF:

Brain-derived neurotropic factor

CBT:

Cognitive-behavioral therapy

CBT-I:

Cognitive-behavioral therapy for insomnia

CI:

Confidence interval

CPAP:

Continuous positive airway pressure

EDS:

Excessive daytime sleepiness

HR:

Hazard ratio

MSFsc:

Mid-sleep on free days corrected for over-sleep on free days

NREM:

Non-rapid eye movement

OR:

Odds ratio

OSA:

Obstructive sleep apnea

PLM:

Periodic limb movements

RBD:

REM sleep behavior disorder

RCTs:

Randomized clinical trials

REM:

Rapid eye movement

RLS:

Restless legs syndrome

SDB:

Sleep-disordered breathing

SMD:

Standardized mean difference

SRMD:

Sleep related movement disorders

SWD:

Sleep-wake disorders

TIA:

Transient ischemic attack

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Funding

This work was supported by the Swiss National Science Foundation (Grant 320030_149752, Grant 33IC30_166827).

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Author notes

  1. Simone B. Duss and Anne-Kathrin Brill contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Bern University Hospital (Inselspital) and University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland

    Simone B. Duss, Panagiotis Bargiotas, Filip Alexiev, Mauro Manconi & Claudio L. Bassetti

  2. Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland

    Simone B. Duss, Anne-Kathrin Brill, Panagiotis Bargiotas, Filip Alexiev & Claudio L. Bassetti

  3. Department of Pulmonary Medicine, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland

    Anne-Kathrin Brill

  4. Center for Experimental Neurology (ZEN), Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland

    Laura Facchin & Claudio L. Bassetti

  5. Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland

    Mauro Manconi

  6. Department of Neurology, Sechenov University, Moscow, Russian Federation

    Claudio L. Bassetti

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Simone B. Duss, Anne-Kathrin Brill, Panagiotis Bargiotas, Laura Facchin, Filip Alexiev, Mauro Manconi, and Claudio L. Bassetti declare no conflict of interest.

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Duss, S.B., Brill, AK., Bargiotas, P. et al. Sleep-Wake Disorders in Stroke—Increased Stroke Risk and Deteriorated Recovery? An Evaluation on the Necessity for Prevention and Treatment. Curr Neurol Neurosci Rep 18, 72 (2018). https://doi.org/10.1007/s11910-018-0879-6

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